Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Study protocol

Hybrid STTR intervention for heterosexuals using anonymous HIV testing and confidential linkage to care: a single arm exploratory trial using respondent-driven sampling

Authors: Marya Gwadz, Charles M. Cleland, Noelle R. Leonard, Alexandra Kutnick, Amanda S. Ritchie, Angela Banfield, Holly Hagan, David C. Perlman, Talaya McCright-Gill, Dawa Sherpa, Belkis Y. Martinez, the BCAP Collaborative Research Team

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

An estimated 14 % of the 1.2 million individuals living with HIV in the U.S. are unaware of their status. Yet this modest proportion of individuals with undiagnosed HIV is linked to 44–66 % of all new infections. Thus innovative intervention approaches are needed to seek out and test those with undiagnosed HIV, and link them to HIV treatment with high retention, an approach referred to as “Seek, Test, Treat, and Retain” (STTR). The present protocol describes a creative “hybrid” STTR approach that uses anonymous HIV testing followed by confidential care linkage, focused on heterosexuals at high risk (HHR) for HIV, who do not test as frequently as, and are diagnosed later, than other risk groups.

Methods/Design

This is a single-arm exploratory intervention efficacy trial. The study has two phases: one to seek out and test HHR, and another to link those found infected to HIV treatment in a timely fashion, with high retention. We will recruit African American/Black and Latino adult HHR who reside in urban locations with high poverty and HIV prevalence. Participants will be recruited with respondent-driven sampling, a peer recruitment method. The “Seek and Test” phase is comprised of a brief, convenient, single-session, anonymous HIV counseling and testing session. The “Treat and Retain” component will engage those newly diagnosed with HIV into a confidential research phase and use a set of procedures called care navigation to link them to HIV primary care. Participants will be followed for 6 months with objective assessment of outcomes (using medical records and biomarkers).

Discussion

Undiagnosed HIV infection is a major public health problem. While anonymous HIV testing is an important part of the HIV testing portfolio, it does not typically include linkage to care. The present study has potential to produce an innovative, brief, cost-effective, and replicable STTR intervention, and thereby reduce racial/ethnic disparities in HIV/AIDS.

Trial Registration

ClinicalTrials.gov, NCT02421159, Registered April 15, 2015.
Literature
1.
2.
Chen M, Rhodes PH, Hall IH, Kilmarx PH, Branson BM, Valleroy LA, et al. Prevalence of undiagnosed HIV infection among persons aged >/=13 years--National HIV Surveillance System, United States, 2005–2008. MMWR Morb Mortal Wkly Rep. 2012;61 Suppl 1:57–64.PubMed
3.
Hall HI, An Q, Tang T, Song RG, Chen M, Green T, et al. Prevalence of diagnosed and undiagnosed HIV infection - United States, 2008–2012. MMWR Morbid Mortal Wkly Rep. 2015;64(24):657–62.
4.
Burns D, Degruttola V, Pilcher C, Kretzschmar M, Gordon CM, Flanagan EH, et al. Towards an endgame: finding and engaging people unaware of their HIV-1 infection in treatment and prevention. AIDS Res Hum Retroviruses. 2014;30(3):217–24.PubMedCentralCrossRefPubMed
5.
Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6.CrossRefPubMed
6.
7.
Sionean C, Le BC, Hageman K, Oster AM, Wejnert C, Hess KL, et al. HIV risk, prevention, and testing behaviors among heterosexuals at increased risk for HIV infection--National HIV Behavioral Surveillance System, 21 U.S. cities, 2010. MMWR Surveill Summ. 2014;63(14):1–39.PubMed
8.
Denning PH, DiNenno EA, Wiegand RE. Characteristics Associated with HIV Infection Among Heterosexuals in Urban Areas with High AIDS Prevalence - 24 Cities, United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2011; 60 (31):1045–49.
9.
10.
Miles IJ, Le BC, Wejnert C, Oster A, DiNenno E, Paz-Bailey G. HIV infection among heterosexuals at increased risk - United States, 2010. MMWR Morbid Mortal Wkly Rep. 2013;62(10):183–8.
11.
Magnus M, Kuo I, Shelley K, Rawls A, Peterson J, Montanez L, et al. Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk. AIDS. 2009;23(10):1277–84.CrossRefPubMed
12.
Jenness SM, Neaigus A, Wendel T, Gelpi-Acosta C, Hagan H. Spatial recruitment bias in respondent-driven sampling: Implications for HIV prevalence estimation in urban heterosexuals. AIDS Behav. 2014;18(12):2366–73.CrossRefPubMed
13.
Flay BR, Snyder F, Petraitis J. The theory of triadic influence. In: DiClimente RJ, Kegler MC, Crosby RA, editors. Emerging theories in health promotion practice and research. New York: Jossey-Bass; 2009. p. 451–510.
14.
Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-testing among Hispanics in the United States: Analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDS. 2005;19(10):672–83.CrossRefPubMed
15.
Herek GM, Capitanio JP. Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic Appl Soc Psych. 1998;20(3):230–41.CrossRef
16.
Schwarcz S, Richards TA, Frank H, Wenzel C, Hsu LC, Chin CS, et al. Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing. AIDS Care. 2011;23(7):892–900.CrossRefPubMed
17.
Ward EG, Disch WB, Schensul JJ, Levy JA. Understanding Low-income, minority older adult self-perceptions of HIV risk. J Assoc Nurses AIDS Care. 2011;22(1):26–37.PubMedCentralCrossRefPubMed
18.
Hartman AF, Radin MB, McConnell B. Parent-to-parent support: a critical component of health care services for families. Issues Compr Pediatr Nurs. 1992;15(1):55–67.CrossRefPubMed
19.
Bond L, Lauby J, Batson H. HIV testing and the role of individual- and structural-level barriers and facilitators. AIDS Care. 2005;17(2):125–40.CrossRefPubMed
20.
21.
Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19 Suppl 2:S67–72.CrossRefPubMed
22.
Jenness SM, Murrill CS, Liu KL, Wendel T, Begier E, Hagan H. Missed opportunities for HIV testing among high-risk heterosexuals. Sex Transm Dis. 2009;36(11):704–10.CrossRefPubMed
23.
Bertolli J, Shouse RL, Beer L, Valverde E, Fagan J, Jenness SM, et al. Using HIV surveillance data to monitor missed opportunities for linkage and engagement in HIV medical care. Open AIDS J. 2012;6:131–41.PubMedCentralCrossRefPubMed
24.
Jenness SM, Myers JE, Neaigus A, Lulek J, Navejas M, Raj-Singh S. Delayed entry into HIV medical care after HIV diagnosis: risk factors and research methods. AIDS Care. 2012;24(10):1240–8.CrossRefPubMed
25.
Tobias CR, Cunningham W, Cabral HD, Cunningham CO, Eldred L, Naar-King S, et al. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDS. 2007;21(6):426–34.CrossRefPubMed
26.
Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.CrossRef
27.
Gwadz M, Cleland C, Hagan H, Jenness S, Kutnick A, Leonard N, et al. Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a “seek, test, treat, and retain” study. BMC Public Health. 2015;15(1):1–14.CrossRef
28.
Abdul-Quader AS, Heckathorn DD, McKnight C, Bramson H, Nemeth C, Sabin K, et al. Effectiveness of respondent-driven sampling for recruiting drug users in New York City: Findings from a pilot study. J Urban Health. 2006;83(3):459–76.PubMedCentralCrossRefPubMed
29.
Salganik MJ, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Methodol. 2004;34:193–239.CrossRef
30.
31.
Broz D, Wejnert C, Pham HT, DiNenno E, Heffelfinger JD, Cribbin M, et al. HIV infection and risk, prevention, and testing behaviors among injecting drug users -- National HIV Behavioral Surveillance System, 20 U.S. cities, 2009. MMWR Surveill Summ. 2014;63(6):1–51.PubMed
32.
Bindman AB, Osmond D, Hecht FM, Lehman JS, Vranizan K, Keane D, et al. Multistate evaluation of anonymous HIV testing and access to medical care. Multistate Evaluation of Surveillance of HIV (MESH) Study Group. JAMA. 1998;280(16):1416–20.CrossRefPubMed
33.
Andersen R, Bozzette S, Shapiro M, St Clair P, Morton S, Crystal S, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study. Health Serv Res. 2000;35(2):389–416.PubMedCentralPubMed
34.
Kegeles SM, Catania JA, Coates TJ, Pollack LM, Lo B. Many people who seek anonymous HIV-antibody testing would avoid it under other circumstances. AIDS. 1990;4(6):585–8.CrossRefPubMed
35.
Grusky O, Roberts KJ, Swanson AN, Joniak E, Leich J, McEvoy G, et al. Anonymous versus confidential HIV testing: client and provider decision making under uncertainty. AIDS Patient Care STDS. 2005;19(3):157–66.CrossRefPubMed
36.
Torian LV, Wiewel EW, Liu KL, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med. 2008;168(11):1181–7.CrossRefPubMed
37.
Turner BJ, Cunningham WE, Duan N, Andersen RM, Shapiro MF, Bozzette SA, et al. Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus. Arch Intern Med. 2000;160(17):2614–22.CrossRefPubMed
38.
Reed JB, Hanson D, McNaghten AD, Bertolli J, Teshale E, Gardner L, et al. HIV testing factors associated with delayed entry into HIV medical care among HIV-infected persons from eighteen states, United States, 2000–2004. AIDS Patient Care STDS. 2009;23(9):765–73.CrossRefPubMed
39.
40.
41.
42.
Bucher JB, Thomas KM, Guzman D, Riley E, De la Cruz N, Bangsberg DR. Community-based rapid HIV testing in homeless and marginally housed adults in San Francisco. HIV Med. 2007;8(1):28–31.CrossRefPubMed
43.
Gardner LI, Metsch LR, Anderson-Mahoney P, Loughlin AM, del Rio C, Strathdee S, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.CrossRefPubMed
44.
Brislin RW. Back-translation for cross-cultural research. J Cross Cult Psychol. 1970; 1:185–216.CrossRef
45.
Heckathorn DD, Semaan S, Broadhead RS, Hughes JJ. Extensions of respondent-driven sampling: a new approach to the study of injection drug users aged 18–25. AIDS Behav. 2002;6(1):55–67.CrossRef
46.
Gwadz MV, Leonard NR, Cleland CM, Riedel M, Banfield A, Mildvan D, et al. The effect of peer-driven intervention on rates of screening for AIDS clinical trials among African Americans and Hispanics. Am J Public Health. 2011;101(6):1096–102.PubMedCentralCrossRefPubMed
47.
Miller WR, Rollnick S. Motivational interviewing: helping people change. New York: Guilford Press; 2012.
48.
Gwadz M, Cleland CM, Belkin M, Ritchie A, Leonard N, Riedel M, et al. ACT2 peer-driven intervention increases enrollment into HIV/AIDS medical studies among African Americans/blacks and Hispanics: a cluster randomized controlled trial. AIDS Behav. 2014;18(12):2409–22.CrossRefPubMed
49.
Chandler RK, Kahana SY, Aklin W, Fletcher B, Jones D, Webb C et al. Enhancing Seek, Test, Treat and Retain Research Through Data Harmonization. Poster presented at the International AIDS Conference: 2012; Washington D. C.; 2012.
50.
51.
Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G. Financial incentive-based approaches for weight loss: a randomized trial. JAMA. 2008;300(22):2631–7.PubMedCentralCrossRefPubMed
52.
Ell K, Vourlekis B, Lee PJ, Xie B. Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev Med. 2007;44(1):26–33.CrossRefPubMed
53.
54.
Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;21 Suppl 1:S49–58.PubMed
55.
Johnston LG, Whitehead S, Simic-Lawson M, Kendall C. Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies. AIDS Care. 2010;22(6):784–92.CrossRefPubMed
56.
McCoy SI, Shiu K, Martz TE, Smith CD, Mattox L, Gluth DR, et al. Improving the efficiency of HIV testing with peer recruitment, financial incentives, and the involvement of persons living with HIV infection. J Acquir Immune Defic Syndr. 2013;63(2):e56–63.CrossRefPubMed
57.
58.
Bunnell R, Ekwaru JP, Solberg P, Wamai N, Bikaako-Kajura W, Were W, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. 2006;20(1):85–92.CrossRefPubMed
59.
Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.CrossRefPubMed
60.
Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397–404.CrossRefPubMed
61.
Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefPubMed
Metadata
Title
Hybrid STTR intervention for heterosexuals using anonymous HIV testing and confidential linkage to care: a single arm exploratory trial using respondent-driven sampling
Authors
Marya Gwadz
Charles M. Cleland
Noelle R. Leonard
Alexandra Kutnick
Amanda S. Ritchie
Angela Banfield
Holly Hagan
David C. Perlman
Talaya McCright-Gill
Dawa Sherpa
Belkis Y. Martinez
the BCAP Collaborative Research Team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2451-5

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Linking social and built environmental factors to the health of public housing residents: a focus group study

Research article

Osteoarthritis prevalence and modifiable factors: a population study

Reviewer acknowledgement

Reviewer acknowledgement 2014

Research article

Assessing care providers’ perceptions and beliefs about physical activity in infants and toddlers: baseline findings from the Baby NAP SACC study

Study protocol

Online gambling’s moderators: how effective? Study protocol for a randomized controlled trial

Research article

The care.data consensus? A qualitative analysis of opinions expressed on Twitter